Provider Demographics
NPI:1326282161
Name:CATHOLIC CHARITIES SERVICES
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-843-5615
Mailing Address - Street 1:3135 EUCLID AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2524
Mailing Address - Country:US
Mailing Address - Phone:216-391-2030
Mailing Address - Fax:216-391-8946
Practice Address - Street 1:3135 EUCLID AVE STE 202
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2524
Practice Address - Country:US
Practice Address - Phone:216-391-2030
Practice Address - Fax:216-391-8946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH892707251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268160Medicaid